Clinical outcomes of lumen-apposing metal stent in the management of benign gastrointestinal strictures: a systematic review and meta-analysis

Abstract

Background and aims: Lumen-apposing metal stent (LAMS) have been considered as a viable alternative to treat benign gastrointestinal (GI) strictures. We aimed to determine the efficacy and safety of LAMS for benign GI strictures.Methods: Medline, Embase, Cochrane, and PubMed databases were searched using the keywords ‘benign stricture’, ‘gastrointestinal stricture’, ‘lumen-apposing metal stent’ and related terms on December 2018. Articles were selected for review by two authors independently according to predefined inclusion criteria and exclusion criteria. A meta-analysis using a random effects model was performed.Results: Six studies with a total of 144 patients were included in the final analysis (60 males, 41.7%). Overall, the pooled technical success rate was 98.3% [95% confidence interval (CI): 0.962–1.004], clinical success rate was 73.8% (95% CI: 0.563–0.912) and adverse events rate was 30.6% (95% CI: 0.187–0.425). The most common complication associated with LAMS for benign GI strictures was migration, and the pooled events rate was 10.9% (95% CI: 0.058–0.160). According to locations of stricture, subgroup analysis was performed in terms of clinical success [Esophagogastric: 63.9% (95% CI: 0.365–0.914); Gastroduodenal: 67.4% (95% CI: 0.421–0.927); Gastrojejunal: 78% (95% CI: 0.638–0.922); Pylorus: 77.6% (95% CI: 0.551–1.002); Colonic: 85.3% (95% CI: 0.515–1.191)].Conclusions: Although the safety of LAMS placement in benign GI strictures is not very satisfactory, it is associated with a low migration rate. LAMS can achieve clinical symptom improvement or resolution in most patients with benign GI strictures, and it might be an alluring prospect for treating patients with this difficult condition.